I' think an arguement could easily be made that a year of RLE might be appropriate before having kids, too.
OK, jokes aside, there's a LOT of misunderstanding here. That's in no small part because the guidelines are deliberately a little vague, so that clinicians have wiggle room, and also because how they get interpreted varies wildly from place to place.
The WPATH guidelines do NOT call for RLE before hormones. Anyone trying to require RLE before hormones is acting OUTSIDE of the established guidelines for transgender care.
The criteria for hormone therapy are as follows:
1. Persistent, well-documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country (if younger, follow the SOC outlined in section VI);
4. If significant medical or mental health concerns are present, they must be reasonably well controlled.
That's all. No RLE.
Again, clinicians trying to require RLE for hormones are acting OUTSIDE of the existing standards of care, and irresponsibly. (Yes, I am aware that the NHS in the UK is still catching up to the modern SOC, but they are working on it.)
Basically, for most folks, the ideal full-transition (from one binary gender to another) would look something like: 6-12 month of hormones, followed by 12 months of RLE as the new gender, followed by GRS/GCS if desired.
There is wiggle room around RLE, don't forget. The requirement for RLE is to experience "12 continuous months of living in a gender role that is congruent with their gender identity."
That doesn't mean that if you were born with male genetalia and want female genetalia that you must go present as a woman for 12 months. It means that you need to present as whatever YOUR target gender identity is for that period of time. The reason why this was tweaked was to allow for a much broader, non-binary specrtum of options. WPATH has recognized that not everyone wants to be a binary gender (this is cool), and is making efforts to expand the WPATH guidelines to allow for whatever presentation fits YOU.
If you've been living as a neutral, non-binary (pick word of your choice here, please!) gender presentation for a couple of years now and hve come to feel that GRS is vital to that presentation, you do NOT need to go get an extra year of RLE as a woman/man to get it, under current guidelines. You just need those 12 months living as your target presentation.
I'm in favor. This is a huge deal. It's a massive, largely irreversible change. There are mental disorders which can also carry gender dysphoria - not common, but neither is being transgender.
In my opinion, it's not a hoop to jump through. It's reaching part of the goal. The goal, after all, is to live life as normally as possible as whatever our target presentation might be... The sooner we get going on that, the better. "RLE" isn't a year. It's the rest of our lives.
